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Bill Nelson: Expanded Medicaid can insure more of the poor

By BILL NELSON, Guest Columnist

Published: Thursday, March 14, 2013 at 1:00 a.m.

Last Modified: Wednesday, March 13, 2013 at 6:40 p.m.

On Feb. 20, Florida Gov. Rick Scott announced he was going to take the federal government up on its offer to cover the cost of Medicaid expansion in Florida. His decision would give health coverage to as many as 1.2 million additional low-income Floridians.

Here's how it would work. Starting in 2014, people who earn less than 138 percent of the federal poverty level, or about $15,000 a year, will have the ability to receive health insurance through Medicaid -- coverage that they currently do not have access to in our state. For the first three years, the federal government will cover the cost of care for these new enrollees.

But last week, the Florida House of Representatives came out against Gov. Scott's decision, saying that expanding Medicaid will cause costs to go up and care to deteriorate. Then this week, a committee in the Florida Senate rejected the Medicaid expansion as proposed by the governor.

It's clear the Legislature has left the door open for an alternative that would privatize Medicaid. But by some estimates that would be way more expensive than simply expanding Medicaid. More specifically, the independent Congressional Budget Office estimates the cost of private insurance as 50 percent more than Medicaid.

In fact, I would argue that the stakes are too high and the cost is too great to not expand the program in the Sunshine State. Here's why:

Right now Florida taxpayers are spending money to treat uninsured children, the disabled and elderly folks when they get sick. When uninsured patients go to the emergency room for uncoordinated and often incredibly expensive care, a lot of hospital bills go unpaid. The state then steps in so hospitals can keep their doors open -- and Florida taxpayers are left picking up the tab.

If Florida agrees to expand Medicaid, people won't have to wait until a cold becomes pneumonia or high blood pressure becomes a heart attack. They can see a primary care physician to help keep diabetes under control or learn about what causes an asthma attack to prevent the next one.

Providing the poor with health coverage for the care they need up front is a smarter way to use money. And, it'll free up funds that were going toward hospital bills for other priorities like education or infrastructure.

It's also important to note that if Florida doesn't take the money the federal government is offering, then other states will. This happened when the governor rejected billions in high-speed rail dollars. Across the country, states are expanding Medicaid, and another state will take the money that's been set aside for the Sunshine State. As Scott pointed out, the health care reform -- which called for Medicaid expansion -- is now the law. So, if we're already paying for it, shouldn't we reap the savings from smarter care?

One major benefit of health reform in the private insurance marketplace is subsidies designed to make insurance affordable. The subsidies are scheduled to start in 2014 and will be available in every state.

But, if Florida turns down the money, those with incomes below 100 percent of the poverty level will not get assistance with health insurance, while many people with higher incomes will still get help paying for coverage. We'll be in the same place we are now -- spending more for worse coverage because people don't have any other option.

In his announcement two weeks ago, Gov. Scott said he could not "in good conscience deny the uninsured access to care." Today, I urge the Legislature to support his decision. How can state lawmakers possibly rationalize their decision not to do so?

The Legislature should not miss this opportunity to take advantage of a health care investment that will reap benefits for all Floridians.

Bill Nelson is Florida's senior U.S. senator and a member of the Senate Commerce, Finance, Budget and Armed Services committees, and chairman of the Special Committee on Aging.

<p>On Feb. 20, Florida Gov. Rick Scott announced he was going to take the federal government up on its offer to cover the cost of Medicaid expansion in Florida. His decision would give health coverage to as many as 1.2 million additional low-income Floridians.</p><p>Here's how it would work. Starting in 2014, people who earn less than 138 percent of the federal poverty level, or about $15,000 a year, will have the ability to receive health insurance through Medicaid -- coverage that they currently do not have access to in our state. For the first three years, the federal government will cover the cost of care for these new enrollees.</p><p>But last week, the Florida House of Representatives came out against Gov. Scott's decision, saying that expanding Medicaid will cause costs to go up and care to deteriorate. Then this week, a committee in the Florida Senate rejected the Medicaid expansion as proposed by the governor.</p><p>It's clear the Legislature has left the door open for an alternative that would privatize Medicaid. But by some estimates that would be way more expensive than simply expanding Medicaid. More specifically, the independent Congressional Budget Office estimates the cost of private insurance as 50 percent more than Medicaid.</p><p>In fact, I would argue that the stakes are too high and the cost is too great to not expand the program in the Sunshine State. Here's why:</p><p>Right now Florida taxpayers are spending money to treat uninsured children, the disabled and elderly folks when they get sick. When uninsured patients go to the emergency room for uncoordinated and often incredibly expensive care, a lot of hospital bills go unpaid. The state then steps in so hospitals can keep their doors open -- and Florida taxpayers are left picking up the tab.</p><p>If Florida agrees to expand Medicaid, people won't have to wait until a cold becomes pneumonia or high blood pressure becomes a heart attack. They can see a primary care physician to help keep diabetes under control or learn about what causes an asthma attack to prevent the next one.</p><p>Providing the poor with health coverage for the care they need up front is a smarter way to use money. And, it'll free up funds that were going toward hospital bills for other priorities like education or infrastructure.</p><p>It's also important to note that if Florida doesn't take the money the federal government is offering, then other states will. This happened when the governor rejected billions in high-speed rail dollars. Across the country, states are expanding Medicaid, and another state will take the money that's been set aside for the Sunshine State. As Scott pointed out, the health care reform -- which called for Medicaid expansion -- is now the law. So, if we're already paying for it, shouldn't we reap the savings from smarter care?</p><p>One major benefit of health reform in the private insurance marketplace is subsidies designed to make insurance affordable. The subsidies are scheduled to start in 2014 and will be available in every state.</p><p>But, if Florida turns down the money, those with incomes below 100 percent of the poverty level will not get assistance with health insurance, while many people with higher incomes will still get help paying for coverage. We'll be in the same place we are now -- spending more for worse coverage because people don't have any other option.</p><p>In his announcement two weeks ago, Gov. Scott said he could not "in good conscience deny the uninsured access to care." Today, I urge the Legislature to support his decision. How can state lawmakers possibly rationalize their decision not to do so?</p><p>The Legislature should not miss this opportunity to take advantage of a health care investment that will reap benefits for all Floridians.</p><p>Bill Nelson is Florida's senior U.S. senator and a member of the Senate Commerce, Finance, Budget and Armed Services committees, and chairman of the Special Committee on Aging.</p>